Healthcare Provider Details

I. General information

NPI: 1972964153
Provider Name (Legal Business Name): TERRY L VOGT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 MURDOCH AVE
SAINT LOUIS MO
63109-2605
US

IV. Provider business mailing address

6437 MURDOCH AVE
SAINT LOUIS MO
63109-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-303-5178
  • Fax:
Mailing address:
  • Phone: 314-303-5178
  • Fax: 314-768-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number089823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: